Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study.

Abstract

BACKGROUND:

The posterior approach for placing continuous interscalene catheters has not been studied in a controlled investigation. In this randomized, triple-masked, placebo-controlled study, we tested the hypothesis that an ultrasound-guided continuous posterior interscalene block provides superior postoperative analgesia compared to a single-injection ropivacaine interscalene block after moderately painful shoulder surgery.

METHODS:

Preoperatively, subjects received a stimulating interscalene catheter using an ultrasound-guided, in-plane posterior approach. All subjects received an initial bolus of ropivacaine. Postoperatively, subjects were discharged with oral analgesics and a portable infusion device containing either ropivacaine 0.2% or normal saline programmed to deliver a perineural infusion over 2 days. The primary outcome was average pain on postoperative day (POD) 1 (scale: 0-10). Secondary outcomes included least and worst pain scores, oral opioid requirements, sleep disturbances, patient satisfaction, and incidence of complications.

RESULTS:

Of the 32 subjects enrolled, 30 perineural catheters were placed per protocol. Continuous ropivacaine perineural infusion (n = 15) produced a statistically and clinically significant reduction in average pain (median [10th-90th percentile]) on POD 1 compared with saline infusion (n = 15) after initial ropivacaine bolus (0.0 [0.0-5.0] versus 3.0 [0.0-6.0], respectively; P < 0.001). Median oral opioid consumption (oxycodone) was lower in the ropivacaine group than in the placebo group on POD 1 (P = 0.002) and POD 2 (P = 0.002). Subjects who received a ropivacaine infusion suffered fewer sleep disturbances than those in the placebo group (P = 0.005 on POD 0 and 1 nights) and rated their satisfaction with analgesia higher than subjects who received normal saline (P < 0.001).

CONCLUSIONS:

Compared to a single-injection interscalene block, a 2-day continuous posterior interscalene block provides greater pain relief, minimizes supplemental opioid requirements, greatly improves sleep quality, and increases patient satisfaction after moderate-to-severe painful outpatient shoulder surgery.

• Authors: Edward R Mariano, Robert Afra, Vanessa J Loland, Navparkash S Sandhu, Richard H Bellars, Michael L Bishop, Gloria S Cheng, Lynna P Choy, Rosalita C Maldonado, Brian M Ilfeld
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 108 Issue 5 Pg. 1688-94 (May 2009) ISSN: 1526-7598 [Electronic] United States
• PMID: 19372355 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Amides
• Anesthetics, Local
• Narcotic Antagonists
• Ropivacaine
• Oxycodone

Topics

• Administration, Oral
• Adult
• Aged
• Amides (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Brachial Plexus (diagnostic imaging)
• Catheters, Indwelling
• Female
• Humans
• Infusion Pumps
• Infusions, Parenteral
• Male
• Middle Aged
• Narcotic Antagonists (administration & dosage)
• Nerve Block (methods)
• Oxycodone (administration & dosage)
• Pain Measurement
• Pain, Postoperative (prevention & control)
• Patient Satisfaction
• Ropivacaine
• Shoulder (surgery)
• Shoulder Pain (prevention & control)
• Sleep (drug effects)
• Treatment Outcome
• Ultrasonography, Interventional